Improving Early Colostrum Administration to Very Low Birth Weight Infants in a Level 3 Neonatal Intensive Care Unit:
Noa Fleiss1, Corinne Morrison2, Allison Nascimento2
1Department of Pediatrics, Division of Neonatology, Yale School of Medicine, New Haven, CT; Bridgeport Campus Neonatal Intensive Care Unit, Yale New Haven Children's Hospital, Bridgeport, CT.
Insights
This study enhanced colostrum oral immune therapy (OIT) for very low birthweight (VLBW) infants. Early OIT administration significantly increased, improving care in neonatal intensive care units.
Area of Science:
- Neonatal care
- Quality improvement science
- Human milk applications
Background:
- Colostrum, rich in immune factors, is crucial for infant health.
- Optimizing human milk use in neonatal intensive care units (NICUs) is essential for vulnerable infants.
- Early and sustained use of colostrum as oral immune therapy (OIT) can enhance immune protection in very low birthweight (VLBW) infants.
Purpose of the Study:
- To improve human milk practices by increasing early and sustained use of colostrum as OIT.
- To enhance immune support for VLBW infants in a level 3 NICU.
Main Methods:
- Implementation of a quality improvement initiative using the Institute for Healthcare Improvement's Model for Improvement.
- Interventions focused on evidence-based guidelines, staff engagement, electronic health record optimization, and lactation consultant involvement.
- Primary outcome: early OIT administration; Secondary outcomes: total OIT administration and human milk at discharge.
Main Results:
- Early OIT administration increased from 6% to 55% over 12 months.
- Total OIT administration to VLBW infants rose from 21% to 85%.
- Human milk at discharge remained stable at 44% without significant improvement.
Conclusions:
- A multidisciplinary quality improvement initiative successfully enhanced OIT administration in a NICU setting.
- The study demonstrates the effectiveness of targeted interventions in improving OIT practices for VLBW infants.
- Further efforts may be needed to improve overall human milk utilization at discharge.
Objective:
To improve our human milk practices by increasing early and sustained use of colostrum as oral immune therapy (OIT) in very low birthweight (VLBW) infants admitted at a level 3 neonatal intensive care unit.
Study Design:
Using the Institute for Healthcare Improvement's Model for Improvement, several interventions aimed at increasing early OIT administration were implemented. Four key drivers included: optimizing evidence-based OIT guidelines, personnel alignment and engagement, optimal electronic health record use for ordering practices, and timely lactation consultant involvement. The primary outcome measure was early OIT administration, whereas secondary outcome measures examined all OIT administration and human milk at discharge. Process measures included the percentage of staff members who were compliant with OIT protocol.
Results:
Early OIT administration increased from a baseline mean of 6% to 55% in the 12-month study period. Percentage of total (early and late) OIT administration to VLBW infants increased from a baseline of 21% to 85%. Average human milk at discharge for VLBW infants remained at 44%, without significant improvement.
Conclusions:
A multidisciplinary quality improvement initiative led to significant improvement in OIT administration to infants at a level 3 neonatal intensive care unit.
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